TY - JOUR
T1 - Implementation and evaluation of a shock curriculum using simulation in Manila, Philippines
T2 - a prospective cohort study
AU - Gardner Yelton, Sarah E.
AU - Ramos, Lorelie Cañete
AU - Reuland, Carolyn J.
AU - Evangelista, Paula Pilar G.
AU - Shilkofski, Nicole A.
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: Shock causes significant morbidity and mortality in children living in resource-limited settings. Simulation has been successfully used as an educational tool for medical professionals internationally. We sought to improve comfort and knowledge regarding shock recognition and fluid management by implementing a pediatric shock curriculum using simulation as an assessment for trainees in Manila, Philippines. Methods: We assessed a shock curriculum focused on patients with malnutrition in a prospective cohort study, using a written test and a videotaped simulation-based objective standardized clinical examination. Implementation occurred in March 2020 with 24 Filipino pediatric residents at a single institution in Manila. Outcomes included time to initiation of fluid resuscitation, improvement in confidence, knowledge on a written assessment, and performance in simulation. Results were compared pre- and post-intervention using Wilcoxon signed-rank test. Results: The time to initiation of fluids did not change between the baseline simulation (median [interquartile range] = 71.5 seconds [52–116.5]) and the final simulation (68 seconds [52.5–89]; P = 0.42). Confidence in identifying shock and malnutrition, managing hypovolemic shock, managing septic shock, and placing intraosseous access all increased (P < 0.01) post-intervention. Written test scores showed no improvement, but performance in simulation, measured using a checklist, improved from a total score of 10 [8.5–11] to 15 [13-16] (P < 0.01). Conclusion: In our study of a simulation-based shock education program, we showed improvement in confidence and knowledge as measured by a resuscitation checklist. It is feasible to establish a successful simulation-based education program in a low-resource setting.
AB - Background: Shock causes significant morbidity and mortality in children living in resource-limited settings. Simulation has been successfully used as an educational tool for medical professionals internationally. We sought to improve comfort and knowledge regarding shock recognition and fluid management by implementing a pediatric shock curriculum using simulation as an assessment for trainees in Manila, Philippines. Methods: We assessed a shock curriculum focused on patients with malnutrition in a prospective cohort study, using a written test and a videotaped simulation-based objective standardized clinical examination. Implementation occurred in March 2020 with 24 Filipino pediatric residents at a single institution in Manila. Outcomes included time to initiation of fluid resuscitation, improvement in confidence, knowledge on a written assessment, and performance in simulation. Results were compared pre- and post-intervention using Wilcoxon signed-rank test. Results: The time to initiation of fluids did not change between the baseline simulation (median [interquartile range] = 71.5 seconds [52–116.5]) and the final simulation (68 seconds [52.5–89]; P = 0.42). Confidence in identifying shock and malnutrition, managing hypovolemic shock, managing septic shock, and placing intraosseous access all increased (P < 0.01) post-intervention. Written test scores showed no improvement, but performance in simulation, measured using a checklist, improved from a total score of 10 [8.5–11] to 15 [13-16] (P < 0.01). Conclusion: In our study of a simulation-based shock education program, we showed improvement in confidence and knowledge as measured by a resuscitation checklist. It is feasible to establish a successful simulation-based education program in a low-resource setting.
KW - Children
KW - Global health
KW - Medical education
KW - Shock
KW - Simulation
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U2 - 10.1186/s12909-022-03669-0
DO - 10.1186/s12909-022-03669-0
M3 - Article
C2 - 35932072
AN - SCOPUS:85135454847
SN - 1472-6920
VL - 22
JO - BMC medical education
JF - BMC medical education
IS - 1
M1 - 606
ER -